Anticoagulation Management

Anticoagulation is the treatment and prevention of blood clots. These clots can block blood flow to important areas of the body, such as the heart, brain, lungs or limbs. Doctors and other health care providers often prescribe anticoagulants to treat people with blood clots in the legs and lungs, and to prevent strokes for people with atrial fibrillation or heart-valve replacement surgery.

The most common anticoagulant prescribed is warfarin, also known as Coumadin®. MultiCare clinics have experience dosing other anticoagulants, such as low-molecular-weight heparins and direct oral anticoagulants.

Centers of Excellence

All of our pharmaceutical resource clinics are designated Anticoagulation Centers of Excellence by the Anticoagulation Forum. Participation in this program demonstrates our ongoing pursuit to achieve the highest level of care and best possible outcomes for our patients. There are only six organizations in Washington state with this designation.

How we help

Your physician will need to refer you to be seen at one of MultiCare’s pharmaceutical resource clinics. You will be contacted by the clinic to schedule an appointment.

At each visit, a pharmacist experienced in anticoagulation treatment will:

• Measure your INR (international normalized ratio) if you are taking warfarin. This is done using a point-of-care meter that requires a small amount of blood from your finger. Accurate results are provided within minutes.
• Assess changes in your health, diet, medications and activities — these can affect anticoagulation therapy.
• Make dose adjustments if necessary and provide verbal and written instructions.
• Provide important information related to anticoagulation therapy, including medication and food interactions, side effects and warning signs.
• Authorize prescription refills for your anticoagulants, if necessary.
• Address your concerns or questions about anticoagulation therapy.

Your first appointment may last 45 minutes — comprehensive education is provided during this visit. Follow-up appointments take about 15 minutes.

If you’re on warfarin therapy, the INR level will be checked about every four to six weeks, and more often when you first begin therapy. Other anticoagulation agents will require routine follow-up at varying frequencies.

Are you a good candidate for home INR monitoring?

Warfarin therapy must be closely monitored to ensure patients are on the right dose. In the past, this meant monthly trips to the pharmaceutical resource clinic for blood work.

MultiCare now offers an easier solution: Patients can test their INR at home with a small, easy-to-use meter, rather than coming to the clinic every month.

Pharmaceutical resource clinics will provide a meter, test strips and all the necessary supplies so you can monitor your anticoagulation therapy at home. You’ll receive face-to-face training with a specialist who is either a pharmacist or nurse. After you’re trained, you’ll provide your INR results every week over the phone or through MyChart. We’ll work with you to make any necessary dosing adjustments.

How does home INR monitoring work?

• Find out if you’re a good candidate: Talk with your pharmaceutical resource clinic provider to find out if you’re a good fit. We’ll help you decide whether it’s right for you.
• Your doctor writes a prescription: If you’ve been identified as a good candidate for home INR monitoring, the pharmaceutical resource clinic will need to obtain a referral and prescription for a meter from your doctor.
• Check with your insurance: The pharmaceutical resource clinic will check with your insurance provider to see if the service is covered and how much it will cost. We’ll let you know the cost before you decide to participate.
• Receive training on the monitor: After you’re trained to use the monitor, you can start testing your INR at home.
• Stay connected with pharmaceutical resource clinic specialists: You’ll report your INR test weekly to the clinic and we’ll provide dosing instructions based on your results.

If you can answer YES to the following questions, you’re likely a good candidate and should discuss home INR monitoring with your pharmaceutical resource clinic provider.

1. Do you take warfarin, or a brand of warfarin such as Coumadin or Jantoven, and plan to take it long term?
2. Do you want to have greater control and stabilization of your INR?
3. Would it be convenient for you to report your results via phone call or MyChart to the pharmaceutical resource clinic?
4. Could you thoroughly follow instructions from our pharmaceutical resource clinic specialists?
5. Are you physically capable of performing a test by taking a finger-stick blood sample, or do you have a caregiver who could assist you?

Contract of care

We’ll follow your care closely, but you must follow exact instructions for drug dosing. It’s important to notify the clinic if you’ve had a recent visit to the emergency department, been hospitalized, started a new medication or had any diet changes.

If you’re unable to keep your appointment, please notify the office to reschedule. Failure to keep appointments or follow instructions could result in serious health risks and/or termination from the program. Please notify the clinic if your phone number changes.